A Mental Health & Lifestyle Blog

Mental Health Care in the Philippines

This month I am back in the Philippines, my favourite place in the whole wide world!

Some of you may know that in 2016 I worked there for a month in
a tiny little state hospital called Western Visayas Medical Centre when I was
training to be a nurse. I worked on the psychiatric ward for three weeks and
A&E for a week. People are always interested to hear about what it was like
so I thought that since I am back over there, I would let everybody know about
my experiences.

My first impressions of the hospital overall were how different it was to ours. There are private hospitals for people with health insurance but the Philippines is a third world country so most people can’t afford it, therefore they have to use the government funded hospitals. It was very damp walking around the medical wards and there were lots of cats wandering around. It was not uncommon to see more than one person sharing a bed, especially on the children’s wards where it could be up to three or four children to one bed. There was no air conditioning and temperatures can reach over 40 degrees in the hottest months so as you can imagine it was SO hot on the wards.

The DOP entrance

The two wards where I spent my time

As with western countries, mental health is the area with the least funding. The entrance to the ward was a big metal gate that was opened and closed only when a new patient was admitted. It’s a requirement there that somebody from the patients’ family must remain with them at all times when they are admitted to the ward, but there is only one single bed per patient so they have to share with each other. There were no mattresses on the beds in psychiatry and each bed had three holes down the side which were used to tie patients to the bed when they became violent or if they were perceived to have done something wrong. I was warned of this before I went and through my time working in mental health I have been involved in many restraints, so I thought I would be okay, but it was incredibly hard to witness.

A bedroom area

The nurses station where medication was dispensed

The ward was divided into three rooms which I think were meant to be gendered but everyone basically just ended up mixing together. As you can imagine it was a busy ward with twice the number of people per beds and there was only one, maybe two nurses on shift at a time to around 30 patients and their accompanying family members. Although the beds were free, food, drink and medication had to be paid for. There was an onsite pharmacy for people to buy medication from but it’s very expensive and often they can only afford one or two tablets at a time, which many of us know renders them pointless. For this reason there are very high rates of relapse and people having multiple admissions. Most people on the ward had either bipolar disorder or schizophrenia but there is also a huge problem with drugs in the Philippines so we saw a lot of people coming through with drug related difficulties. IM medication is also very expensive for the hospital so when people require any sort of rapid tranquilisation they are essentially forced to swallow a tablet.

An example of purchasing medication from the pharmacy

There
are hundreds of languages in the Philippines so many people speak English as
shared language. All medical notes and handovers were in English as were
presentations. I attended a medical presentation whilst there and was surprised
to learn that they use the DSM-V and are very advanced in their education, but
just don’t have the money to put the evidence based treatments into their
practice. Nurses train for four years rather than the three in the UK, and make
approximately £1200 per year. They are also required to work for free for a few
weeks after qualifying. Despite this, they are some of the kindest, happiest
and most skilled nurses I have had the pleasure of working with.

The morning dance routine

An afternoon karaoke session

Every day on the psychiatric ward there were activities; we did a dance routine every morning and in the afternoon we would do bracelet making, arts and crafts, drawing and an absolute favourite in the Philippines – karaoke. They love it there! Sometimes I would help them do their makeup (men and women – they are very accepting of all genders and sexualities), and spend hours talking about their pasts and their families. I was particularly close with two patients there, one of whom drew me a beautiful picture and other of whom made me a lovely bracelet, both of which I still have.

A beautiful drawing of me

One thing that struck me the whole time I was there was how kind, happy and grateful each person was for the care they were receiving. I didn’t witness a single person being rude to the nurses or to each other even when very distressed, and in fact everybody shared everything they had with each other even if they had very little themselves. There was a real feeling of everybody being in it together and making the best of a difficult situation.

Every
morning when I came to the ward the patients would wait at the gate for me and
say ‘Good morning ma’am Cara!’ which was my favourite greeting ever and I was
highly disappointed that no-one addressed me like this once I got back home.

The Emergency Room

I am aware that mental health care in the NHS is not acceptable in the current state it is in, but I have so much appreciation for it having seen how other places have to manage. This is also why, whenever I am offered anything from the mental health system I engage with it to the best of my ability. I am incredibly grateful for any and all support I am given – though this doesn’t make it okay when care isn’t up to scratch. I did struggle a little when I got back at times when I was being verbally abused at work because I had been part of this other system and seen how people treated each other so kindly.

Me outside the hospital on my first day

The Philippines is colloquially referred to as the ‘happiest place in the world’ and I really do believe that to be true.

It’s the best place I have ever been (with Bali coming a very close second) and I am so, so happy to be back here in my home away from home.

I can attest to this as a Filipino: we have dismal public hospitals (our Department of Health – the equivalent of NHS in the UK – is seriously underfunded) and a rather outdated view of mental health. Some of the public hospitals in Manila aren’t well maintained – and more so in the provinces.

For the second point, there’s now a growing awareness of mental health concerns but there are still some isolated stories (I kid you not) of people with severe mental disorders being chained to trees or imprisoned in makeshift huts.

That’s terrible! I have to say although there was many parts of it in which care wasn’t good enough compared to western hospitals, the nurses were so kind and gentle. It’s one of the things that made me fall in love with the country!

From how I see it, such an attitude from the nurses stems from the Filipino cultural value of being ma-alaga (caring) – especially towards the elderly and children. It’s akin to giving back, or paying it forward, in some way — the care they received as children is passed on to other people who need it.